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What is that pain in my shoulder?

Patients suffering a non-traumatic, painful, but mobile shoulder are often provided with a wide range of diagnostic labels for their shoulder pain. Terms like:

  • subacromial bursitis
  • subacromial impingement
  • rotator cuff tendinopathy
  • rotator cuff related shoulder pain (RCRSP)

  This variability can often cause uncertainty for patients with regard to the cause, diagnosis and prognosis of their shoulder pain. Further, some of these diagnostic terms may have the potential to lead patients down suboptimal treatment pathways.  

Recently, a consensus process was undertaken to provide insight to understanding the most appropriate diagnostic terms, examination procedures, prognosis and optimal non-surgical management of such shoulder pain.  

The consensus concluded that the term ‘Rotator cuff related shoulder pain’ is a preferred descriptor for pain in the anterolateral upper arm, which is activity dependent, made worse with overhead activities or by taking the arm behind back, with minimal pain at rest apart from when laying on the affected shoulder.  

This should be confirmed through physical examination to confirm that passive movement is maintained, and that familiar pain/weakness is demonstrated upon resisted testing.   

There remains a lot of uncertainty with regard to what consists as optimal non-surgical management in those presenting with rotator cuff related shoulder pain (RCRSP).  

Progressive loading over a minimum period of 12-weeks seems a preferred approach to treatment, alongside graded exposure to painful movements.   

Management strategies should also consider the functional limitations, expectations and beliefs of patients, and rehabilitation should be designed in a way that is multi-dimensional within a biopsychosocial framework, ensuring that the wider determinants of health are considered.  

Imaging should be reserved for potential red flag presentations or if the patient does not respond as expected.  

Steroid injections should be discouraged unless pain is severe and acting as a barrier to rehabilitation.   

Non-surgical management has demonstrated outcomes equivalent to surgical intervention (subacromial decompression) for patients presenting with RCRSP, and surgery has no proven superiority over sham intervention.  

Brett Doring - Director, Physiotherapist

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